Loan Request Information

Loan Purpose: 
Select One home purchase, property indentified home purchase, still looking for property refinance debt consolidation cash back home improvement

Type of Loan Requested:
Select One 1st mortgage home purchase 1st mortgage refinance - no cash back 1st mortgage refinance - cash back 2nd mortgage home equity loan home equity line of credit 125% no equity loan

Requested Loan Amount:
$

When do you need this loan?
Select One immediately 10-20 days 21-30 days 31-60+ days no time frame

Which statement best describes your current loan needs?
Select One I have not contacted a lender I need to talk with a mortgage expert and discuss my options I am looking for a lender and comparing loans I am currently working with a lender, but looking at other loan options I am currently working with a lender, but dissatisfied with the service

Property Information

Subject Property Address
(if home purchase, your current address)

Subject Property is a:
Select One house condominium townhouse 2-4 plex manufactured home mobile home other
(if home purchase, please choose what you're interested in)

Current Property Value:
$
(for home purchase, please enter sales price)

If home purchase, choose % amount of down payment:
Select One Not Applicable 0% 3% 5-10% 11-20% 21-30% 30%+

Current Mortgage Information
(if home purchase, go to the About Yourself section)

Month and year your property was acquired:
Month (mm) Year (yyyy)

Original cost:
$

Current first mortage balance:
$

Rate on first mortgage:
%

Current mortgage is a:
Select One fixed adjustable balloon not sure/other

Monthly payment on first mortgage:
$

Monthly payment include taxes and insurance?
Please Select from the List Below Yes No

Do you have a 2nd mortgage?
(if not, skip to Please Tell Us About Yourself)
Select One Yes No

Balance on 2nd Mortgage:
$

Rate on 2nd Mortgage:
%

Monthly payment on 2nd Mortgage:
$

Please Tell Us About Yourself

Please Tell Us About Your Employment

Self-Employed?
Select One Yes No

Length of Employment:
Select One 0-6 Months 7-12 Months 1-2 Years 3+ Years

Gross Monthly Income:
$

Please Tell Us About Your Co-Borrower
(if this does not apply, skip and go to credit history)

Self-Employed?
Select One Yes No

Length of Employment:
Select One 0-6 Months 7-12 Months 1-2 Years 3+ Years

Gross Monthly Income:
$

Credit History

How is your credit rating?
Select One Excellent Good OK Some Problems Major Problems Don't Know

Have you ever declared bankruptcy?
Select One Never, not in the past 7 years Less than 12 months 1-2 years 2-5 years 5-7 years

Total revolving credit balance:
(credit cards, department stores, etc)
$

Total revolving monthly payment:
$

Total installment credit balance:
(car payment, student loans, etc)
$

Total installment monthly payment:
$

Comments

How Did You Hear About Us?

Select One referral previous customer referral friend/family referral real estate agent Home Locator magazine website website banner ad other Internet Pennysaver newspaper Reader Television radio yellow pages mailer other